Provider Demographics
NPI:1407037195
Name:SELF, JULIA MURDOCH
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MURDOCH
Last Name:SELF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:
Practice Address - Street 1:128 MEDICAL PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8579
Practice Address - Country:US
Practice Address - Phone:704-696-2085
Practice Address - Fax:704-658-9328
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50163732363LP0200X
GA207951NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN207951NPOtherGEORGIA
FL9267190OtherARNP LICENSE